Provider Demographics
NPI:1689637076
Name:WHETSTONE, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:WHETSTONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7433 LAS COLINAS BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7575
Mailing Address - Country:US
Mailing Address - Phone:972-831-8822
Mailing Address - Fax:972-831-8858
Practice Address - Street 1:7433 LAS COLINAS BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7575
Practice Address - Country:US
Practice Address - Phone:972-831-8822
Practice Address - Fax:972-831-8858
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5764174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B15LMedicare ID - Type Unspecified
TXB27532Medicare UPIN